Global Health Africa contributor, Patrick Saunders Hastings, draws attention to lymphatic filariasis, a neglected tropical disease also known as elephantiasis.

Lymphatic filariasis (LF) is a neglected tropical disease (NTD) caused by three species of thread-like nematode worms. The clinical symptoms of the infection involve skin fissures and painful swelling of the legs, genitals, and breasts. The second most common global cause of long-term disability, LF is endemic in 82 countries in Africa, Asia, South America, and the Pacific, afflicting over 120 million people. Severe morbidity arises from acute episodes of inflammation called adenolymphangitis, while social and economic well-being are severely compromised by stigmatization resulting from the debilitating and disfiguring nature of the disease. Manifestations of such exclusion include limited marriage and employment prospects, while shame associated with affliction can reduce motivation to seek treatment. These issues further reduce the economic independence of patients, perpetuating the cycle of poverty faced by those afflicted with LF.

Figure 1. LF results in painful swelling of the legs, genitals, and breasts.

In 1997, the World Health Organization (WHO) classified LF as one of six infectious maladies where there was sufficient diagnostic and treatment capability to potentially eradicate the disease. In response to this, the Global Program to Eliminate Lymphatic Filariasis (GPELF) was set up in 2000, aiming to “eliminate LF as a public health problem by 2020”. This goal was to be accomplished through a “two-pillar” system, combining the interruption of transmission through annual mass drug administration (MDA) covering at least 80% of the at-risk population for at least five years, and morbidity management through the provision of care for those already infected. Elimination programs are conducted on national scales, operating at the community level to improve local relevance, drug coverage, and compliance.

To date, over one billion treatments have been given, with the annual number gradually increasing over time. Around 64% of endemic countries have begun MDA, while another 12% have low levels of transmission that are unlikely to require MDA. In 2008, 695 million people were offered MDA, and 496 million participated. Since 2000,  millions of people have been protected from LF infection, resulting in pronounced benefits including savings of approximately 24.2 billion USD. Educational and awareness campaigns have also been effective in increasing knowledge, reducing stigma, and improving practices associated with the disease. Moreover, this initiative has promoted country and community ownership and empowerment, and served as a platform for integration with other health programs such as control of other NTDs

Figure 2. African LF-endemic countries and territories by MDA (2007)

However, despite the successes of the MDA program, many countries have not been able to achieve sufficient drug coverage to interrupt disease transmission, even after implementing the recommended annual MDA for over 5 years. Meanwhile, 16 of the 19 countries that require MDA, but have not begun, are located in Africa. Key barriers and challenges include co-endemicity with other diseases, fragile infrastructures, and post-conflict situations. In addition, morbidity management has been largely neglected in favor of MDA, with only 35% of endemic countries implementing any sort of disability service. While celebration of past successes is warranted, recognition of short-comings and anticipation of current and future challenges is vital to achieving success over the next six years. Although significant progress has been made, there is still much to be done

References

Addiss, D. (2010). The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis: A half-time review of lymphatic filariasis elimination and its integration with the control of other neglected tropical diseases. Parasites and Vectors 3(1), 100.

Bangoura, O. (2008) “Health system approaches to NTD control”. 5^th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis. Arusha, Tanzania pp. 36-40.

Bockarie, M. & Deb, R. (2010). Elimination of lymphatic filariasis: do we have the drugs to complete the job? Current Opinion in Infectious Diseases 23(6), 617-20.

El-Setouchy, M. (2003). Stigma reduction and improved knowledge and attitudes towards filariasis using a comic book for children. Journal of the Egyptian Society of Parisitology, 33, 55-65

Molyneux, D. (2003). Lymphatic Filariasis (Elephantiasis) Elimination: A public health success and development opportunity. Filaria Journal, 2, 13.